Analysis of voriconazole trough plasma concentrations in critical patients / 药物评价研究

ABSTRACT

Objective To observe the changes in voriconazole plasma trough concentration in critical patients,and explore its optimal dosage.Methods A retrospective analysis was carried out in critical patients with voriconazole and voriconazole therapeutic drug monitoring (TDM) in intensive care unit (ICU) of the Affiliated Drum Tower Hospital of Nanjing University Medical School from December 2014 to December 2016.The patients' age,sex,dose,and other general information,voriconazole trough concentrations,influence of proton pump inhibitors (PPIs) on plasma trough concentrations,efficacy were analyzed retrospectively.Results 150 times of voriconazole plasma trough concentration in 99 patients were enrolled,and it was found that only 76.00％ (114/150) reached the target concentration (1-5.5 mg/L),13.33％ (17/150) ＜ 1 mg/L and 12.67％ (19/150) ＞ 20 mg/L.Significant difference was observed between old patients (≥60 years old) and other patients (＜ 60 years old) (P ＜ 0.05),age (P =0.000) was found to be correlated to plasma trough concentrations by multiple linear regression analysis,but sex,body weight,weighted dose,APACHE2 score,total bilirubin and albumin don,t;there was no significant difference of plasma trough concentration of voriconazole between the use of PPIs,the concentration tended to increase with pantoprazole (P =0.054),and was statistically different compared with that of esomeprazole (P =0.036);There was no significant difference in mortality between patients with targeting trongh plasma concentrations and those without (x2 =0.059,P =0.809).Conclutions Voriconazole plasma trough concentration has great variation between individuals,so constant monitoring is necessary.Age and the combination of PPIs show a relatively significant influence on the serum trough concentrations,and they should be taken into consideration in dosage to be given.